Critical Incident Stress Management (C.I.S.M.) A Basic Introduction Montgomery County CISM Team
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Critical Incident Critical Incident Stress Management Stress Management (C.I.S.M.) (C.I.S.M.) A Basic Introduction A Basic Introduction Montgomery County CISM Team Montgomery County CISM Team
Critical Incident Stress Management (C.I.S.M.) A Basic Introduction Montgomery County CISM Team
Critical Incident Stress Management (C.I.S.M.) A Basic
Introduction Montgomery County CISM Team
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Montgomery County Critical Incident Stress Management
Montgomery County Critical Incident Stress Management Who takes
care of the caregivers?
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Critical Incidents Events that have the potential to create
significant human distress and can overwhelm ones usual coping
mechanisms.
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What is a Critical Incident? n Death or injury of a coworker n
Death or major injury to a child n Situations involving extensive
media coverage n Prolonged situation with negative outcome n
Mistakes, real or imagined n Victim previously known to person n
Natural Disasters
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What is Critical Incident Stress? n Emotional, mental, and/or
physical response which interferes with behavior, or the ability to
function either on scene or after the incident is over. As defined
by Dr. Jeffrey T. Mitchell Ph.D.
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n The type of stress you experience is dependant on 4 Ps n
Perception - How one views an event n Planning - Training and
preparation n Preparedness - Ones expectations of the stimuli n
Past - The baggage you carry from previous experiences What
Determines How You Will React?
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Coping Mechanisms n Denial (Things just dont bother me) n
Titanic Syndrome (Im invincible and unsinkable) n Image Armor
(Admission of pain is seen as a sign of weakness) n Anger n Blame n
Dark Humor
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Exposure Control n While working with a patient... You may have
gotten exposed to an infection n Would you seek treatment?
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Exposure Control After an exposure, a physician may prescribe
some prophylactic medication CISM is the prescription following an
exposure to stress
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The Goals of CISM are: n Early Recognition Identifying a
potentially stressful situation n Activation Page the CISM
Coordinator n Suppression Set up an Intervention n Prevent burnout
n Encourage the well being of personnel, careers, and families
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San Diego vs. Cerritos
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The Tale of Two Plane Crashes San Diego n 125 killed-no
survivors n 16 homes destroyed n 15 civilians killed on ground n
300 EMS personnel n > 10,000 body parts Cerritos n 82 killed-no
survivors n 16 homes destroyed n 15 civilians killed on ground n
300 EMS personnel n > 10,000 body parts
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Impact of CISM San Diego n No CISM Services provided n Lost
police - 5 in one yr. n Lost fire - 5 in one yr. n Lost paramedics
- 15 in one yr. n Increase in mental health services - 31% Cerritos
n 12 CISM Demobilizations n Hotline Follow-up n No loss of police
or fire personnel n 1 paramedic loss n Increase in mental health
services - 1%
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What is Stress? n Your reaction to stimuli Physical
Mental/Cognitive Emotional n Stress comes in two forms Eustress
Distress
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What is Distress? n A disruptive force that negatively impacts
daily health- Mitchell & Bray Physical- Change in eating
patterns Mental/Cognitive- Inability to recall simple information
Emotional- Hypersensitivity
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What is Eustress? n The positive, motivating reactions to
situations Driving force to do your best Physical - Exercise Mental
- Academics Emotional - Optimism
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Psychological Crisis An acute response to a trauma, disaster,
or other critical incident wherein: 1) Psychological balance is
disrupted 2) Ones usual coping mechanisms have failed 3) Evidence
of significant distress, impairment, dysfunction
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Terrorism represents a form of psychological warfare The war
will ultimately be won or lost not on the battlefield, but in the
mind
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Crisis Intervention was developed in response to the acute
mental health needs of those in crisis
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Crisis Assessments
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Acute Mental Status Assessment n Orientation n Long-term Memory
n Concentration n Emotion
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What is cumulative stress? n Chronic progressive culmination of
small stressors May result in P.T.S.D., if not managed. n Warning:
Contents under extreme pressure!
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Cumulative and Long-Term Effects of Stress n Hindrance of
performance n Decreased ability to make decisions n Memory problems
n Interpersonal Conflicts n Morale problems n Accident prone n
Absenteeism n Depression n Burnout and Attrition n Suicide
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P.T.S.D. (Post -Traumatic Stress Disorder) n This is a
pathological reaction to an abnormal situation Symptoms inhibit the
person from functioning at his/her job May have day or night
terrors
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More P.T.S.D. Hypersensitivity May experience intrusive
thoughts (flashbacks) Symptoms MUST last for over 30 days n Early
Recognition and intervention may prevent the domino effect
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Critical Incident Stress Management n ...is a comprehensive,
organized approach for the reaction, and control of harmful aspects
of stress. Jeffrey T. Mitchell Ph.D. Forms of intervention:
Pre-incident Education Debriefing (C.I.S.D.) Defusing Crisis
Management Briefing (CMB) Demobilization 1:1
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For Whom is C.I.S.M. Targeted? n Normal people experiencing
normal reactions to abnormal situations
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C.I.S.M. is not for CRAZY People! n C.I.S.M. is not designed to
be therapy or a replacement for therapy
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Critical Incident Stress Debriefing n is a method for
mitigating the harmful effects of work-related trauma, and
ultimately preventing P.T.S.D. Jeffrey T. Mitchell Ph.D.
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What is a Defusing? n A small group process which is initiated
after any traumatic event that is powerful enough to overwhelm ones
usual coping mechanisms n Short version of a Debriefing
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What Does Defusing Mean? n Means to render something harmless
before it can do damage n Overall objective is to reduce the
potential for harm to those who were exposed to a critical
incident
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Usual Effects of Defusings n May possibly eliminate need for
formal Debriefing n It will enhance effectiveness of Debriefing
process if one is needed
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Defusing Goals n Achieve a rapid reduction in the intense
reactions to a traumatic event n Attempt to normalize the
experience n Attempt to re-establish the social helping network of
the group n Assess need for formal Debriefing process
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Additional Goals of Defusings n Information transfer between
members n Re-focusing of thinking process; getting your act
together n Education as to survival skills over next few days n
Identifying support resources/personnel
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Debriefing - What is It? n A formal peer group discussion
designed to help alleviate the effects of critical incident stress
n A prevention program for burn-out
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What Happens at a Debriefing? n Team n Location n Phases
Introduction Fact Thought Reaction Symptom/teaching Re-entry
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Introduction Phase n Introduce members n Establish ground rules
n Explain process
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Fact Phase n Who are you and what was your job, or how were you
involved in the incident? n What happened from your point of
view?
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Thought Phase n What was your first or most prominent thought
once you came off auto pilot?
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Symptom Phase n The group is asked to describe: Any cognitive,
physical, emotional or behavioral symptoms they experienced at the
scene Symptoms they experienced in the following days Symptoms they
continue to experience
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Teaching Phase n All team members teach about symptoms one may
experience n Find a positive outcome, or gift that may have come
out of tragedy n Utmost concern for group
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Re-entry Phase n Clarify issues n Answer questions n Team
members make summary comments
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Follow-up and Referral n May return for another debriefing if
group decides n May have an individual who may ask for further
help
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Signs and Symptoms n Physical Chest Pain Elevated BP Headaches
Muscle tremors n Cognitive Confusion Poor attention Intrusive
images Nightmares
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Signs and Symptoms n Emotional Guilt Anxiety Depression n
Behavior Withdraw Loss of or increase in appetite Changes in sleep
patterns Increased alcohol consumption
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The Keys to Unlocking a Successful Career After a Critical
Incident: Helping a Peer n Listen carefully n Spend time with the
traumatized person n Help with everyday tasks n Know your
limitations as a peer supporter
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The Keys to Unlocking a Successful Career Helping yourself *
Eat well-balanced and regular meals Drink plenty of water * Get
plenty of rest * Structure your time - Keep busy * Allow yourself
to be emotional * Look to your peers and family for support
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Pre-Incident Strategies n Eat Properly n Exercise n Rest n Talk
Must practice/do/engage in regularly
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Post-Incident Strategies n Eat Properly n Exercise n Rest n
Talk
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Montgomery County Critical Incident Stress Management Team
Department of Public Safety Division of EMS and the Office of
Mental Health
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History of the Montgomery County CISM Program n Trained
Emergency Services Peers n Mental Health Professionals n All
Volunteers n Services are free
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Main goals of CISM n To jump start your natural support systems
n To help keep your baggage at a manageable level n To get you back
to work and functioning at an optimal level after a critical
incident
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Team Make-up n Mental Health Professionals n EMS/ Medical
Professionals Peers First Responders, EMTs, Paramedics, PHRNs,
Nurses, Physicians n Police Officers Peers Active, and retired n
Firefighters, Rescue, Water Rescue Peers n Dispatcher Peers n
Clergy n Community Service Peers
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The expanding role of CISM n Services for families of Emergency
Services Personnel n Industrial First Responders n Proactive
Training & Education n Community Group Crisis
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Who Can Activate CISM? n CISM may be activated by any member of
any Emergency Service in Montgomery County It is advised that these
requests go through a supervisor or an administrator n CISM may be
activated by other community service groups
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How to Access the Team n CISM can be activated through: n
Montgomery County Emergency Dispatch Service 911or610-631-6541
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STRESS IMPAIRS THE ABILITY TO CARE AND PERFORM
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Special thanks to Marc Borish, NYC Regional EMS CISM
Coordinator (and formerly the Chester County CISM Coordinator) for
the preparation of the text portion of this presentation